Cutting balloon to treat carotid in-stent stenosis: technical note

Carotid artery in-stent stenosis, a possible long-term complication of carotid angioplasty and stenting, is currently treated by inflation of a non-compliant angioplasty balloon. Better initial results and less recurrence of stenosis have been documented in the coronary literature with the use of the Cutting Balloon (CB, Boston Scientific Interventional Technologies, San Diego, California) for angioplasty, in comparison with traditional balloon angioplasty. We report our collective experience with the use of the CB to treat carotid in-stent stenosis in three patients. Excellent angiographic and clinical results were achieved. No complications occurred. The lesions in two patients were successfully treated with the CB alone; adjunctive stent placement was required in a third patient. Our experience demonstrates the feasibility and safety of the CB for the treatment of carotid in-stent stenosis in three patients. Due to the less traumatic nature of this balloon, its use may result in a lower occurrence of in-stent stenosis as compared to a conventional angioplasty balloon. To our knowledge, this is the first report of the use of the CB for carotid in-stent stenosis.